|
NM Kidney Imaging w/ Flow w/o Pharm
|
Facility
|
IP
|
$2,281.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
631451
|
| Min. Negotiated Rate |
$1,117.69 |
| Max. Negotiated Rate |
$2,098.52 |
| Rate for Payer: Aetna Commercial |
$2,052.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,961.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.93
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cigna Commercial |
$2,098.52
|
| Rate for Payer: Health EOS Commercial |
$2,030.09
|
| Rate for Payer: HFN Commercial |
$2,098.52
|
| Rate for Payer: Multiplan Commercial |
$1,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,098.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.69
|
| Rate for Payer: Quartz Commercial |
$1,368.60
|
| Rate for Payer: WEA Trust Commercial |
$1,254.55
|
| Rate for Payer: WPS Commercial |
$1,689.54
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Professional
|
Both
|
$2,742.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
631440
|
| Min. Negotiated Rate |
$602.89 |
| Max. Negotiated Rate |
$2,604.90 |
| Rate for Payer: Aetna Commercial |
$2,604.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.12
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,604.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,371.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,645.20
|
| Rate for Payer: Health EOS Commercial |
$2,495.22
|
| Rate for Payer: HFN Commercial |
$2,604.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$602.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$602.89
|
| Rate for Payer: Multiplan Commercial |
$2,193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,604.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.48
|
| Rate for Payer: Quartz Commercial |
$1,562.94
|
| Rate for Payer: The Alliance Commercial |
$1,371.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.10
|
| Rate for Payer: WPS Commercial |
$2,031.00
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2586887
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$602.89 |
| Max. Negotiated Rate |
$2,671.40 |
| Rate for Payer: Aetna Commercial |
$2,671.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,418.32
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,671.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,406.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,687.20
|
| Rate for Payer: Health EOS Commercial |
$2,558.92
|
| Rate for Payer: HFN Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$602.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$602.89
|
| Rate for Payer: Multiplan Commercial |
$2,249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,671.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.28
|
| Rate for Payer: Quartz Commercial |
$1,602.84
|
| Rate for Payer: The Alliance Commercial |
$1,406.00
|
| Rate for Payer: WEA Trust Commercial |
$1,546.60
|
| Rate for Payer: WPS Commercial |
$2,082.85
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2586887
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,587.04 |
| Rate for Payer: Aetna Commercial |
$2,530.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,418.32
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,003.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,602.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.58
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,490.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$534.24
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,587.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,573.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,502.68
|
| Rate for Payer: HFN Commercial |
$2,587.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,987.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$534.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$534.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$534.24
|
| Rate for Payer: Multiplan Commercial |
$2,249.60
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,587.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,377.88
|
| Rate for Payer: Quartz Commercial |
$1,827.80
|
| Rate for Payer: Quartz Medicare Advantage |
$534.24
|
| Rate for Payer: The Alliance Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.24
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,546.60
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,082.85
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
OP
|
$2,742.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
631440
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,522.64 |
| Rate for Payer: Aetna Commercial |
$2,467.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.12
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.16
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$534.24
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,522.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,440.38
|
| Rate for Payer: HFN Commercial |
$2,522.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,987.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$534.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$534.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$534.24
|
| Rate for Payer: Multiplan Commercial |
$2,193.60
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,522.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.58
|
| Rate for Payer: Quartz Commercial |
$1,782.30
|
| Rate for Payer: Quartz Medicare Advantage |
$534.24
|
| Rate for Payer: The Alliance Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.24
|
| Rate for Payer: WEA Trust Commercial |
$1,508.10
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,031.00
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2586887
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,377.88 |
| Max. Negotiated Rate |
$2,587.04 |
| Rate for Payer: Aetna Commercial |
$2,530.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,418.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,490.36
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,587.04
|
| Rate for Payer: Health EOS Commercial |
$2,502.68
|
| Rate for Payer: HFN Commercial |
$2,587.04
|
| Rate for Payer: Multiplan Commercial |
$2,249.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,687.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,587.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,377.88
|
| Rate for Payer: Quartz Commercial |
$1,687.20
|
| Rate for Payer: WEA Trust Commercial |
$1,546.60
|
| Rate for Payer: WPS Commercial |
$2,082.85
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
IP
|
$2,742.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
631440
|
| Min. Negotiated Rate |
$1,343.58 |
| Max. Negotiated Rate |
$2,522.64 |
| Rate for Payer: Aetna Commercial |
$2,467.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.26
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,522.64
|
| Rate for Payer: Health EOS Commercial |
$2,440.38
|
| Rate for Payer: HFN Commercial |
$2,522.64
|
| Rate for Payer: Multiplan Commercial |
$2,193.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,522.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.58
|
| Rate for Payer: Quartz Commercial |
$1,645.20
|
| Rate for Payer: WEA Trust Commercial |
$1,508.10
|
| Rate for Payer: WPS Commercial |
$2,031.00
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
IP
|
$3,527.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
2586885
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,728.23 |
| Max. Negotiated Rate |
$3,244.84 |
| Rate for Payer: Aetna Commercial |
$3,174.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,033.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,869.31
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,244.84
|
| Rate for Payer: Health EOS Commercial |
$3,139.03
|
| Rate for Payer: HFN Commercial |
$3,244.84
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,116.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,244.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,728.23
|
| Rate for Payer: Quartz Commercial |
$2,116.20
|
| Rate for Payer: WEA Trust Commercial |
$1,939.85
|
| Rate for Payer: WPS Commercial |
$2,612.45
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
IP
|
$3,267.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
631445
|
| Min. Negotiated Rate |
$1,600.83 |
| Max. Negotiated Rate |
$3,005.64 |
| Rate for Payer: Aetna Commercial |
$2,940.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,809.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,731.51
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna Commercial |
$3,005.64
|
| Rate for Payer: Health EOS Commercial |
$2,907.63
|
| Rate for Payer: HFN Commercial |
$3,005.64
|
| Rate for Payer: Multiplan Commercial |
$2,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,960.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,005.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,600.83
|
| Rate for Payer: Quartz Commercial |
$1,960.20
|
| Rate for Payer: WEA Trust Commercial |
$1,796.85
|
| Rate for Payer: WPS Commercial |
$2,419.87
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Professional
|
Both
|
$3,267.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
631445
|
| Min. Negotiated Rate |
$1,256.40 |
| Max. Negotiated Rate |
$3,103.65 |
| Rate for Payer: Aetna Commercial |
$3,103.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,809.62
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna Commercial |
$3,103.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,633.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.20
|
| Rate for Payer: Health EOS Commercial |
$2,972.97
|
| Rate for Payer: HFN Commercial |
$3,103.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,256.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,256.40
|
| Rate for Payer: Multiplan Commercial |
$2,613.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,103.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,437.48
|
| Rate for Payer: Quartz Commercial |
$1,862.19
|
| Rate for Payer: The Alliance Commercial |
$1,633.50
|
| Rate for Payer: WEA Trust Commercial |
$1,796.85
|
| Rate for Payer: WPS Commercial |
$2,419.87
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
OP
|
$3,267.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
631445
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$3,005.64 |
| Rate for Payer: Aetna Commercial |
$2,940.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,809.62
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,123.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,633.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,568.16
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,731.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$534.24
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna Commercial |
$3,005.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,828.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,907.63
|
| Rate for Payer: HFN Commercial |
$3,005.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,987.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$534.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$534.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$534.24
|
| Rate for Payer: Multiplan Commercial |
$2,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,005.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,600.83
|
| Rate for Payer: Quartz Commercial |
$2,123.55
|
| Rate for Payer: Quartz Medicare Advantage |
$534.24
|
| Rate for Payer: The Alliance Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.24
|
| Rate for Payer: WEA Trust Commercial |
$1,796.85
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,419.87
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
OP
|
$3,527.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
2586885
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$3,244.84 |
| Rate for Payer: Aetna Commercial |
$3,174.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,033.22
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,003.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,602.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.58
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,869.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$534.24
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,244.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,973.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$3,139.03
|
| Rate for Payer: HFN Commercial |
$3,244.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,987.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$534.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$534.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$534.24
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,244.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,728.23
|
| Rate for Payer: Quartz Commercial |
$2,292.55
|
| Rate for Payer: Quartz Medicare Advantage |
$534.24
|
| Rate for Payer: The Alliance Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.24
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,939.85
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,612.45
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Professional
|
Both
|
$3,527.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
2586885
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,256.40 |
| Max. Negotiated Rate |
$3,350.65 |
| Rate for Payer: Aetna Commercial |
$3,350.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,033.22
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,350.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,763.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,116.20
|
| Rate for Payer: Health EOS Commercial |
$3,209.57
|
| Rate for Payer: HFN Commercial |
$3,350.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,256.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,256.40
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,350.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.88
|
| Rate for Payer: Quartz Commercial |
$2,010.39
|
| Rate for Payer: The Alliance Commercial |
$1,763.50
|
| Rate for Payer: WEA Trust Commercial |
$1,939.85
|
| Rate for Payer: WPS Commercial |
$2,612.45
|
|
|
NM Liver Imaging w/ Vascular Flow
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,438.64 |
| Max. Negotiated Rate |
$2,701.12 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,761.60
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
NM Liver Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,701.12 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,908.40
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
NM Liver Imaging w/ Vascular Flow
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$2,789.20 |
| Rate for Payer: Aetna Commercial |
$2,789.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,789.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,468.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,761.60
|
| Rate for Payer: Health EOS Commercial |
$2,671.76
|
| Rate for Payer: HFN Commercial |
$2,789.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.19
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,789.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,291.84
|
| Rate for Payer: Quartz Commercial |
$1,673.52
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
IP
|
$2,612.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
2586903
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,279.88 |
| Max. Negotiated Rate |
$2,403.04 |
| Rate for Payer: Aetna Commercial |
$2,350.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.36
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,403.04
|
| Rate for Payer: Health EOS Commercial |
$2,324.68
|
| Rate for Payer: HFN Commercial |
$2,403.04
|
| Rate for Payer: Multiplan Commercial |
$2,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,567.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.88
|
| Rate for Payer: Quartz Commercial |
$1,567.20
|
| Rate for Payer: WEA Trust Commercial |
$1,436.60
|
| Rate for Payer: WPS Commercial |
$1,934.71
|
|
|
NM Liver/Spleen Imaging
|
Professional
|
Both
|
$2,418.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
631331
|
| Min. Negotiated Rate |
$667.06 |
| Max. Negotiated Rate |
$2,297.10 |
| Rate for Payer: Aetna Commercial |
$2,297.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,079.48
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$2,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,209.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.80
|
| Rate for Payer: Health EOS Commercial |
$2,200.38
|
| Rate for Payer: HFN Commercial |
$2,297.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$667.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$667.06
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,297.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.92
|
| Rate for Payer: Quartz Commercial |
$1,378.26
|
| Rate for Payer: The Alliance Commercial |
$1,209.00
|
| Rate for Payer: WEA Trust Commercial |
$1,329.90
|
| Rate for Payer: WPS Commercial |
$1,791.01
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
OP
|
$2,612.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
2586903
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,403.04 |
| Rate for Payer: Aetna Commercial |
$2,350.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.32
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,403.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,324.68
|
| Rate for Payer: HFN Commercial |
$2,403.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$2,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.88
|
| Rate for Payer: Quartz Commercial |
$1,697.80
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,436.60
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,934.71
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
631331
|
| Min. Negotiated Rate |
$1,184.82 |
| Max. Negotiated Rate |
$2,224.56 |
| Rate for Payer: Aetna Commercial |
$2,176.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,079.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.54
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$2,224.56
|
| Rate for Payer: Health EOS Commercial |
$2,152.02
|
| Rate for Payer: HFN Commercial |
$2,224.56
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,224.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.82
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,329.90
|
| Rate for Payer: WPS Commercial |
$1,791.01
|
|
|
NM Liver/Spleen Imaging
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
2586903
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$667.06 |
| Max. Negotiated Rate |
$2,481.40 |
| Rate for Payer: Aetna Commercial |
$2,481.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.32
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,481.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,306.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,567.20
|
| Rate for Payer: Health EOS Commercial |
$2,376.92
|
| Rate for Payer: HFN Commercial |
$2,481.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$667.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$667.06
|
| Rate for Payer: Multiplan Commercial |
$2,089.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,481.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.28
|
| Rate for Payer: Quartz Commercial |
$1,488.84
|
| Rate for Payer: The Alliance Commercial |
$1,306.00
|
| Rate for Payer: WEA Trust Commercial |
$1,436.60
|
| Rate for Payer: WPS Commercial |
$1,934.71
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
631331
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,224.56 |
| Rate for Payer: Aetna Commercial |
$2,176.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,079.48
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,209.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.64
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$2,224.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,353.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,152.02
|
| Rate for Payer: HFN Commercial |
$2,224.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,224.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.82
|
| Rate for Payer: Quartz Commercial |
$1,571.70
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$1,329.90
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,791.01
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$2,789.20 |
| Rate for Payer: Aetna Commercial |
$2,789.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,789.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,468.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,761.60
|
| Rate for Payer: Health EOS Commercial |
$2,671.76
|
| Rate for Payer: HFN Commercial |
$2,789.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.19
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,789.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,291.84
|
| Rate for Payer: Quartz Commercial |
$1,673.52
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,438.64 |
| Max. Negotiated Rate |
$2,701.12 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,761.60
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,701.12 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,908.40
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
